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Prehospital Point of Care Testing Paul A. Berlin, MS, NREMT-P. EMS POC is here today Provides EMS providers with valuable information leading to better treatment plans Can help direct patients to appropriate receiving centers Increases capability and professionalism of EMS providers.

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Prehospital point of care testing paul a berlin ms nremt p
Prehospital Point of Care TestingPaul A. Berlin, MS, NREMT-P

  • EMS POC is here today

  • Provides EMS providers with valuable information leading to better treatment plans

  • Can help direct patients to appropriate receiving centers

  • Increases capability and professionalism of EMS providers


Point of care testing
Point-of-Care Testing

  • POC devices fall into two general categories:

    • QUANTITATIVE devices which are normally an electronic instrument that measures the quantity of whatever substance is being tested for in a blood sample (an example of which would be an electronic glucometer which shows the blood sugar in mg/dL)

    • QUALITATIVE devices which usually contain chemically treated paper that changes color to indicate the presence of the specific substance being tested for (an example of which would be a colormetric CO2 detector)


Measure what
Measure What?

  • Electrolytes: Sodium, potassium, chloride, BUN, anion gap, base excess, bicarbonate, glucose levels

  • Blood: Hematocrit, hemoglobin

  • Blood Gas: pH, CO2, PO2

  • Coagulation: Prothrombin time

  • Cardiac enzymes: Cardiac troponin-I, BNP, CK-MB, myogloblin and H-FABP

  • And More


Getting poc
Getting POC

  • Costs: $--$$$$

    • Cartridges

    • Analyzers

    • Accessories

    • Service Contract

  • Regulations:

    • Clinical Laboratory Improvement Amendments (CLIA)

    • CMS


80 year old female
80 Year Old Female

  • Decreased LOC

  • Likely been on the floor for days

  • Her BP is 70/50 mm/Hg, pulse is 60 bpm, respirations are 8/min and she only responds to deep pain

POC test shows potassium (K+) of 9.2 mEq/L (3.5-5.5 mEq/L).

  • Treatment plan now includes giving CaCl2, Bicarbonate and Albuterol.


56 year old female
56 Year Old Female

  • Reports intermittent, “funny feeling” in her right arm and neck for the past four days. She has a history of hypertension and takes medication. She is diabetic. She wants to stay home.

Troponin I on this patient is 8.5


37 year old marathon runner
37 Year Old Marathon Runner

  • Complains of headache and confusion 30 minutes after finishing.

  • Suddenly has tonic-clonic seizure lasting 90 seconds.

  • Electrolytes:

    • Sodium 112 mEq/L (135-148 mEq/L)

    • Potassium 3.5 mEq/L (3.5-5.5 mEq/L)

  • Glucose:

    • 90 mg/dL (60-99 mg/dL)

  • Dx: Dilutional Hyponatremia


Respiratory distress
Respiratory Distress

  • Elderly patient with a recent strokeand a history of coronary artery disease calls 911 for help

  • On examination, he has expiratory wheezing, tachypnea and is nowstuporous

  • Oximetry reads 96% on 6 L oxygen flow by nasal cannula

  • Temperature is 96.7° F orally

  • An ECG shows a left bundle branch block

  • B-type natriuretic peptide (BNP) is 1100 pg/ml indicating heart failure.


Getting poc1
Getting POC

  • Training:

    • Sample handling

    • Unit operations

    • Annual refresher

  • QA:

    • Testing the test

    • Oversight

  • Expectations of ED

    • Will the except your test

    • Getting “buy-in”


References
References

  • 1. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation. 2005;112:IV-121-IV-125.

  • 2. Part 8: Stabilization of the Patient With Acute Coronary Syndromes. Circulation. 2005;112:IV-89-IV-110

  • 3. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation. 2005;112:IV-121-IV-125.

  • 4. Differentiating the Causes of Metabolic Acidosis in the Poisoned Patient. Clinics in Laboratory Medicine - Volume 26, Issue 1 (March 2006)

  • 5. Modern Management of Cardiogenic Pulmonary Edema. Emergency Medicine Clinics of North America; Volume 23, Issue 4 (November 2005).

  • 6. Part 9: Adult Stroke. Circulation. 2005;112:IV-111-IV-120

  • 7. Point-of-Care Testing and Cardiac Biomarkers: The Standard of Care and Vision for Chest Pain Centers. Cardiology Clinics - Volume 23, Issue 4 (November 2005)

  • 8. Point-of-Care Testing Reduces Length of Stay in Emergency Department Chest Pain Patients. Annals of Emergency Medicine - Volume 45, Issue 6 (June 2005)

  • 9. Patient safety in point-of-care testing. Clinics in Laboratory Medicine - Volume 24, Issue 4 (December 2004)